The complex components of female-to-male gender-confirmation surgery can be safely and effectively accomplished in one stage, according to new research published in the Journal of Sexual Medicine.

The approach, which includes the removal of female characteristics and creation of male ones, has similar complication rates as multistage surgeries, the authors noted. A one-stage procedure might also take less time to perform, with lower costs and a shorter hospital stay for patients.

Typically, surgical transition is conducted in multiple stages. The first steps, hysterectomy and bilateral mastectomy, may be done in one or two stages. Later, patients undergo genital reconstruction, which usually needs two stages.

Over the last decade, gender-confirmation surgery has improved, the authors said. With these developments in mind, the researchers analyzed their one-stage approach, considering surgical time, length of hospital stay, complication rates, and need for revision surgery.

The current study focused on 79 female-to-male patients who underwent one-stage gender-confirmation surgery between January 2007 and March 2016. The patients ranged in age from 18 to 43 years, with an average of 25.5 years. All had had hormonal treatment for an average of 3 years before surgery. The average follow-up time was 44 months.

Performed by teams of expert gynecologists and gender surgeons, each patient’s surgery included the following:

• Bilateral mastectomy (removal of both breasts)
• Vaginectomy (removal of the vagina)
• Hysterectomy (removal of the uterus)
• Oophorectomy (removal of the ovaries)
• Metoidioplasty with urethral lengthening (reconstruction of the genitals)

The average time frame for surgery was 270 minutes, and patients stayed in the hospital for 3 to 6 days.

About a quarter of the patients experienced complications, and approximately 11% had revision surgery. Complications included excessive bleeding, breast hematoma, problems with the reconstructed urethra, and rejection of testicular implants.

Over 96% of the patients were satisfied with the appearance of their new genitalia. All could eventually urinate while standing. In addition, 95% were satisfied with their erections, and all were satisfied with the erogenous sensations in the new penis.

All of the participants said they could become sexually aroused, and 86% could reach orgasm during masturbation. Eighty-seven percent were satisfied with their sexual function overall.

“The main advantages of this approach are minimal blood loss, acceptable length of surgery, fast recovery, low complication rate, and no special difference compared with each of these procedures performed separately in a multistage manner,” the authors wrote, adding, “Patients have an important benefit in avoiding multiple operations under general anesthesia (i.e., saving time and decreasing costs) without increased surgery risks and complication rates.”

An experienced, multidisciplinary team of surgeons is critical for success, they said. However, they cautioned that more research, along with comparisons to other approaches, is needed before the one-stage approach can be recommended.